Pericarditis
From IDWiki
Definition
- Inflammation or infection of the pericardia sac
Etiology
- Idiopathic (most common)
- Infectious
- Viral
- Coxsackievirus
- Echovirus
- Adenovirus
- Others: Epstein-Barr virus, cytomegalovirus, influenza, varicella, rubella, HIV, hepatitis B, mumps, parvovirus B19, vaccinia (smallpox vaccine)
- Mycobacterial: tuberculosis
- Bacterial
- Staphylococcus aureus
- Streptococcus pneumoniae
- Haemophilus influenzae
- Neisseria meningitidis
- Others: Chlamydia psittaci and C. trachomatis, Legionella, Salmonella, Borrelia burgdorferi, Mycoplasma, Actinomyces, Nocardia, Tropheryma whippelii, Treponema, Rickettsia, Listeria
- Fungal: Histoplasma, Aspergillus, Blastomyces, Coccidioides, Candida
- Parasitic: Echinococcus, amebic, Toxoplasma
- Viral
- Non-infectious
- Malignancy
- Primary: rhabdomyosarcoma, teratoma, fibroma, lipoma, leiomyoma, angioma
- Metastatic: lung, breast, Hodgkin lymphoma, leukemia, melanoma
- Autoimmune
- Post-MI: either early or late (Dressler syndrome)
- Metabolic: uremia, hypothyroidism
- Radiation
- Malignancy
Clinical Manifestations
- Positional chest pain, often several weeks following viral infection (most commonly Coxsackievirus)
Diagnosis
- Based on 2 of 4 features
- Positional chest pain
- EKG shows PR depression, then diffuse ST elevation with upsloping, then ST depression, then T-wave inversions, then T-wave normalization
- Evolves over weeks
- Echo
- Rub
Investigations
- Labs: lytes/creatinine (for NSAID safety), troponins
- Echocardiogram
- ECG
- Stage I: diffuse ST elevation with PR depression
- Stage II: normalization of ST and PR segments
- Stage III: diffuse deep T-wave inversions
- Stage IV: normalization of the ECG
Evolution of ECG in pericarditis
Management
- Mainstay of treatment is NSAIDs for 1-2 weeks, tapered over another 2-3 weeks
- ASA 650mg po qid with pantoprazole
- Indomethacin
- Adjunctive colchicine for 3 months
- If refractory or NSAID allergy: steroids with a slow taper
- Increased recurrence rate
